Anorexia

“ It is not more easy to give a pathological explanation of anorexia as an effect of phthisis than when the symptom occurs in connection with other diseases not involving either inflammation or any ascertained structural affection of the digestive organs. ”

“ If it be possible without the scammony to evacuate by a large dose of aloes, it will be better, because the scammony is bad for the stomach. When the anorexia proceeds from thick and viscid humours, you may cure them by attenuating and incisive remedies, such as oxymel, and the preparations from it and brine, as capers, olives, mustard, and the like. The remedies recommended for anorexia from a cold intemperament are not inapplicable to these, and more particularly after evacuation. ”

“ Impaired power of digestion and anorexia are bad prognostics. Especially bad is a degree of anorexia in which not only no desire for food is felt, but it is so loathed as to render adequate alimentation impossible. ”

“ The symptoms which have been referred to primary atrophy of the stomach are severe anæmia and disturbances of digestion, such as anorexia, eructations, and vomiting. The digestive disturbances are often not greater than are frequently observed in cases of severe anæmia. ”

“ Anorexia was usually complete during pyrexia, and not rarely patients were admitted to the hospital who asserted that for one or more days they had not taken any nourishment whatever. Under such circumstances, and in a disease where the tendency to prostration and cardiac failure calls for stimulants and food, it is evident that strict care must be given to the diet. In many cases skimmed milk with lime-water, meat broths, arrowroot, or gruel, could be taken in small amounts at short intervals, and retained. ”

“ It is progressive action that should always be sought.
The quantity of aliment may be reduced either by imposing an always uniform regimen, which soon begets anorexia and disgust, or by withholding from the food a considerable quantity of fat, or, finally, by forbidding beverage during meals. Emaciation is obtained readily enough in either way, and demands only the constant exercise of will power on the part of the patient; but unhappily, severe regimen cannot always be prescribed. When the obese patient has passed the age of forty; when the heart suffers from degeneration ”

“ Paresis sensitiva. Weakness of the whole system from insensibility.
ORDO II. Decreased Sensation. GENUS II. Of Particular Organs. SPECIES.
1. Anorexia. Want of appetite. Some elderly people, and those debilitated by fermented liquors, are liable to lose their appetite for animal food; which is probably in part owing to the deficiency of gastric acid, as well as to the general decay of the system: elderly people will go on years without animal food; but inebriates soon sink, when their digestion becomes so far impaired. ”

“ A still more effectual remedy is aloes dissolved in water. For those who cannot retain their food (who were particularly called stomachics by the ancients) , mix with honey the flour of fenugreek and the dried seed of mallows in powder, and apply. The cerate consisting of wax, the lees of oil of iris, and castor, is also proper.
On anorexia. Anorexia is a loathing of food, either from the prevalence of an intemperament in the stomach, or a collection of humours. ”

“ It is not any single symptom which is decisive; it is rather the combination, the mode of onset, and the course of the symptoms, which are of most importance in diagnosis.
Impairment of the appetite is the rule in gastric cancer. Anorexia is sometimes a marked symptom before pain, vomiting, and other evidences of gastric indigestion are noted. There is often a special distaste for meat. The appetite may be capricious; it is very rarely even increased. There are exceptional cases in which the appetite is preserved throughout the greater part or even the whole course of the disease. ”

“ Cases appear to have got well with change of air and a better diet after resisting all ordinary means. In other instances no benefit whatever has been derived from residence at the sea or in the mountains. As a rule, the cases are best treated at home. The greatest care must be exercised in the regulation of the diet, which should be light and nutritious. So long as the digestion keeps tolerably active there is hope: anorexia, vomiting, and other dyspeptic symptoms are among the most troublesome and serious features. The bitter tonics, hydrochloric acid, and pepsin may be administered. ”

“ In visiting lunatic asylums in this and other countries, I have been struck with the140 appearance of groups of patients—the similarity of their physique, as compared with the men and women seen on our streets every day—fat or lean, seldom medium—all exhibiting clearly the physical characteristics of disease, as emaciation, obesity, lack of, or ravenous, appetite, usually the latter. Meal-time comes every five or six hours, and if the appetite is good, all are permitted to eat very much in excess of their needs; they are urged to eat when they desire to fast ”

“ These include diabetes, gout, arthritis, rheumatism, rickets, scurvy, obesity, emaciation, adiposis dolorosa, and various disorders of the liver, heart, and the circulatory system; also constipation and dozens of disorders under the broad term of autointoxication.
The first step in the practise of scientific eating should be to limit the quantity of food, or, in many cases, to take a complete fast for a brief time.
In the slow stages of human development, Nature seems to have accommodated herself to man's omnivorous habits of eating. ”

“ Hunger, in other words, is normally the signal that the stomach is contracted for action; the unpleasantness of hunger leads to eating; eating starts gastric digestion, and abolishes the sensation. Meanwhile the pancreatic and intestinal juices, as well as bile, have been prepared in the duodenum to receive the oncoming chyme. The periodic activity of the alimentary canal in fasting, therefore, is not solely the source of hunger pangs, but is at the same time an exhibition in the digestive organs of readiness for prompt attack on the food swallowed by the hungry animal. ”

“ The consequences are, that hunger soon returns, and the party must either have recourse to food between the usual time of meals, or suffer the consequences of imperfect nutrition. Exercise and labour, within certain limits, promote the healthy functions of the stomach and bowels, through the action of the muscles of the abdomen increasing the peristaltic motion of these viscera. An inordinate appetite in persons leading a sedentary life is generally indicative of the food passing off imperfectly digested, or of the coats of the stomach being relaxed, or even diseased. ”

“ Associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. By the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc. ”

“ The overeating causes overweight in those whose nutrition is above par and indigestion in those who have but ordinary digestive capacity. Those who are overweight have too high blood pressure and those who have indigestion absorb some of the poisonous products of decomposition from the bowels. Headache is a common result. Palpitation of the heart comes from gas pressure. The abnormal blood pressure may result in albuminurea, swelling of the lower extremities and overweight of both mother and child. The morning sickness is nearly always due to excessive food intake. ”

“ The character of the disease also has much to do with the preliminary diet. In certain pathological conditions involving the gastro-intestinal tract, for example, the patient comes to the surgeon after medical treatment has failed to give relief and surgical intervention is necessary to save life. The body is found to be in a condition bordering on starvation, anemic and exhausted from insufficient nourishment. The functions of the blood-making organs have become out of gear, as it were, and the blood consequently is deficient in one or more of its essential elements. ”

“ When food is filtered into the body after having become liquified and made alkaline, or, at least neutral, by saliva, the appetite is given a chance to measure the needs of the body and to discriminate against excess. As soon as the point of complete saturation of any one deficiency is reached, the appetite is cut off, as short as possible to imagine, with no indication of stomach fullness. It will welcome a little of proteid in beans, cheese, eggs, or in some other of its richer forms, and then turn to sugar or fat in some of their numerous forms. ”

“ It is obvious in these cases that the indication is to promote digestion by exciting a flow of appetite juice, and not to rely upon that excited by chemical stimuli. From this point of view the meaning of removing a patient, the subject of chronic weakness of the stomach, from his customary surroundings is also plain. Take, for instance, a mentally overstrained individual, or a responsible official; how often does it happen that he cannot for a moment distract his thoughts from his daily work. He eats without noticing it, or eats and carries on his work at the same time. ”

“ The external appearance of such cases of obesity, which we have described before the French Congress of Medicine in 1904, and the London Pathological Society, February 21, 1905, as endogenous obesity, is also clinically different from the appearance of those caused by overfeeding. As we have shown, persons addicted to rich food, with little exercise, are often red in the face, and are plethoric; they easily become overheated and perspire freely. They seldom complain of constipation. ”

“ The vigorous appetite, which is perfectly natural during a period of growth and great bodily activity, remains at first unimpaired, and impels the individual to eat an amount of food far beyond the present necessities of the system or the powers of digestion. The consequence is a tendency, not only to fulness from excessive nutrition, but to severe digestive disorder from the stomach and intestines being weakened both by want of exercise and by excess of food. I have known many instances of dyspepsia, constipation, and mental affection, and even of active inflammation, thus produced. ”

“ Hunger is the normal demand for food, expressed through the salivary glands. Appetite is the desire for liquor, coffee, tobacco, morphin, etc., and for food when one habitually overeats. It is expressed by an empty feeling or craving in the stomach, while hunger is felt only in the salivary glands, and in the region of the throat and the mouth. Appetite weakens the body; hunger stimulates thought and action.
Normal hunger can be produced by limiting the quantity of food below the actual needs of the body, for three or four days, or perhaps a week. ”

“ Such preparations are a severe tax upon even robust persons—they are fatal to consumptives. It is infinitely worse than bribing an exhausted laborer, who can scarcely move a muscle, to rouse himself to fresh tasks. He will do more and better work by reason of present and absolute rest; and the same is true of the sick stomach: there will be a relish for the coarsest article of diet—aye, it will be delicious—and digestion will wait on appetite, when the nutritive organs shall have been restored by sufficient rest. ”

“ And rest, as we have said before, is to nerves what food is to the stomach and oxygen to the lungs.
A common result of faulty digestion is a tendency to grow fat. Just as extreme thinness results from failure to digest food properly and so get the nourishment out{283} of it, so a certain kind of obesity is likewise a wrong digestion of food; and though the symptom of “laying on flesh” is often ignorantly considered a sign of health, it may be distinctly a sign of bad digestion, if the flesh that is laid on is fatty. Certain foods, such as sugar and oil, are in themselves fattening ”

“ Do not, if by care you can prevent it, allow your stomach to become disordered; but if, in spite of care, it is irritated, soothe instead of punishing it. Manage it as you sometimes control a fretful child,—by letting it severely alone. A few hours' fasting is an excellent remedy, and may continue until a feeling of faintness warns you that nature needs your assistance. Then eat slowly a little light food, such as milk-toast or very hot beef-tea. Quiet and diet work more wonders than quarts of medicine. ”

“ Exercise after Eating.—Severe mental and vigorous bodily exercise immediately after a meal retards gastric digestion. The entrance of food into the stomach excites the free flow of gastric juice, which, like all the secreting processes, is dependent upon a flux of blood to the secreting glands. Other parts of the body, notably the brain, suffer from temporary anemia, and hence the great tendency to drowsiness after eating a hearty meal. ”

“ Water is subtracted in such amounts that the body dries; even the skin becomes dry, and the tongue may cleave to the roof of the mouth. Furthermore, much [Pg 25] otherwise available food energy is lost with sugar in the urine. As much as a pound of sugar may be passed in a day. Consequently, the tissues starve in the midst of plenty. The appetite, therefore, is sharpened, but the more the patient eats, the greater becomes the wastage of food energy, and the more severe the symptoms. ”

“ From this I finally learned a most valuable lesson, viz: that the craving appetite that tempts one to forestall the regular meal hour is a species of “poison-hunger,” akin to that which torments the inebriate if his customary dram is not forthcoming. In either case, whether the congested stomach seems to crave solid or liquid stimulants, the only wise thing is to abstain, remove or relieve the inflammatory state of the stomach by giving it rest from digestive labor, and by judicious drinking of pure water, and then eat and drink so as to prevent a recurrence of the disorder. ”